Disclaimer: This write up does not represent the Ministry of Health of Malaysia or University Malaysia Sarawak. It is based on my personal opinion & observation as a Public Health Doctor.

The ongoing debate is whether Microcephaly in Brazil is associated / causes / related to Zika Virus or not.

It is definitely a difficult task to pinpoint on something. There are still many uncertainties about Zika.

Is history repeating? Remember the Pellagra infection theory? whereby 100,000 deaths was recorded in a small maize growing town in the United States due to delay in identifying the root cause of the outbreak.

What about Zika & Microcephaly? Is microcephalus caused by isotretinoin cream (Vit A derivatives) application or consumption? (Isotretinoin are also used for beautification treatment)

Now lets compare,

“The health authorities in Brazil said that there are reported cases of microcephaly — a rare condition in which infants are born with abnormally small heads — had climbed to 4,180 since October, a 7 percent increase from the previous tally last week. Before the epidemic, Brazil recorded only about 150 cases of microcephaly a year”

“More than 2,100 pregnant Colombian women are infected with the mosquito-borne Zika virus, the country's national health institute said on Saturday, as the disease continues its spread across the Americas”.

“The virus has been linked to the devastating birth defect microcephaly, which prevents fetus' brains from developing properly. There is no vaccine or treatment”

“There are 20,297 confirmed cases of the disease in Colombia, the national health institute said in a epidemiology bulletin, among them 2,116 pregnant women”

“However, there are so far NO reported cases of MICROCEPHALY or deaths from the virus in Colombia”

Keep in mind that both these news indireclty explains that there are other possibilites or confounding factors that contributes to Microcephaly. Brazil reports Zika and Microcephaly while Columbia’s cases are reported to have no microcephaly or deaths from the same Zika virus.

Going back to our story about Pellagra.

In 1735, something happened in the United States. Pellagra is a vitamindeficiency disease most frequently caused by a chronic lack of niacin (vitamin B3 or synonym: vitamin PP) (from: Pellagra Preventing factor) in the diet.

More than 100,000 people died in the United States as health authorities treated it as an infection, and refused to accept it as a vitamin related disorder. They were to busy trying to prevent its spread through water, human contact etc. Things became out of hand,….too late….thousands died. Some researchers even ate the faeces, sweat, & saliva of the Pellagra patients to prove that it was not infective. The Health Authorities did not accept the findings.

Apparently, this particular small town in the US had introduced a new machine that accidentally removes (shears) the outer layer of a Maize, hence removing the niacin-vitamin PP.

Finally, Casimir Funk, who helped elucidate the role of thiamin in the etiology of beriberi, was an early investigator of the problem of pellagra. Funk suggested that a change in the method of milling corn was responsible for the outbreak of pellagra, but no attention was paid to his article on this subject.

One fine day…….when the maize shearing machine & milling technique was imporved, the (maize was eaten with the outer layer)…..Pellagra disappeared from the town.

Sadly the solution was discovered after a few hundred thousand deaths….

Returning back to our discussion on Zika and microcephaly. Do you all know what is Isoretinoids?

Isotretinoin is a form of vitamin A. It reduces the amount of oil released by oil glands in your skin, and helps your skin renew itself more quickly. Isotretinoin is used to treat severe nodular acne that has not responded to other treatments, including antibiotics.

​Isotretinoin ingestion during the first trimester of human pregnancy can induce malformations of the skull, ears, face, central nervous system, eyes, palate, lungs, circulatory system, limbs, and digits. A single oral dose of isotretinoin on day 8 of gestation in hamsters induces a similar syndrome of congenital malformation

​Brazil has been importing massive amount of Isoretinoids. The last known contract was given on 2014. I quote from the article "Brazil is the largest isotretinoin market in Latin America, with annual sales exceeding CDN$50 million, and the market has been growing solidly, providing a compelling opportunity for our novel formulation."

If a women uses facial & body cream-with Isoretinoids (derivative of vitamin A), there are high possibilities of giving birth to microcephalic baby (misshapen skull). Once this cream is used, it can stay in the body for more than 5 years (anecdotal / some literatures are available). This cream is commonly used & sold illegally in certain areas in Asia & Latin America as well. I am not saying that pharma companies are responsible for this (This is still my assumption) but lets divert our attention to the chemical substance that could possibly cause this defect (I might be wrong too). These creams could be the one of reason of microcephaly and I strongly believe other cofounding factors and variables exists that could contribute to this event as well. Now, Is Zika virus really causing microcephalus in Brazil?

Microcephalus is highly reported in Brazil; Brazil reports almost 150 cases of microcephalus annualy. Second question, are they prescribing to this kind of beautification cream (illegal creams) that contains Isotretinoin?

Keep in mind that Isotretinoin in high doses can affect the nervous system, causes genetic malformation on DNA and the obvious reason of microcephaly as well.

Well….we knew this was coming. We had the knowledge about the distribution of Aedes aegypti on the global scale, so why did we choose to be silent and react only when there is chaos? In order to stop a deadly outbreak, you gotta stop the bureacractic approach first, and trust me everything else will fall in place.